


send a referral

by sunnilee



Series: blue lions: for the (medical) record [4]
Category: Fire Emblem: Fuukasetsugetsu | Fire Emblem: Three Houses
Genre: F/M, Feelings Realization, Medicine AU, completely forgot this was just sitting there done, got murdered in august, i wrote this back in july
Language: English
Status: Completed
Published: 2020-09-05
Updated: 2020-09-05
Packaged: 2021-03-06 21:07:49
Rating: General Audiences
Warnings: Creator Chose Not To Use Archive Warnings
Chapters: 3
Words: 2,346
Publisher: archiveofourown.org
Story URL: https://archiveofourown.org/works/26305351
Author URL: https://archiveofourown.org/users/sunnilee/pseuds/sunnilee
Summary: Sylvain's got a several week history of new onset abdominal discomfort and possible reflux.He needs a referral for proper diagnosis and management.Stat.
Relationships: Ingrid Brandl Galatea/Sylvain Jose Gautier
Series: blue lions: for the (medical) record [4]
Series URL: https://archiveofourown.org/series/1769470
Comments: 42
Kudos: 31





	1. chief complaint

**Author's Note:**

  * For [livmoores](https://archiveofourown.org/users/livmoores/gifts).



It first strikes Sylvain when he watches Ingrid devour three burgers without breaking a sweat after a long, _grueling_ , seven hours in the anatomy lab. Their practical was coming up soon and Ingrid wanted to review all the abdominal anatomy, one last time.

Then, it was 9 in the evening and he’s sitting across from his childhood best friend who has the biggest smile on her face with her greasy fingers and ketchup stained mouth and he feels his stomach churn uncomfortably, a burning rising in the back of his throat.

He crosses an arm over his abdomen and coughs twice, trying to clear his throat. Ingrid’s just finished her last bite and she raises an eyebrow. “Catching a cold?”

Sylvain frowns as his stomach rolls over again. “Or a stomach bug.”

Her eyes drop down to his half-finished meal. He snorts and pushes his plate toward her. Even though he feels like his insides are doing somersaults, the way Ingrid’s face lights up eases the nausea building in his chest.

They get back to their apartment and he retreats to his shared room with Felix, one arm still crossed over his abdomen. Felix is hunched over his anatomy notes and doesn’t even turn to acknowledge him when he opens and shuts the door behind him. Sylvain flops onto his bed and squeezes his eyes shut, another wave of nausea washing over him. He groans and flings an arm over his face. “Felix?”

He hears another page turn, but no response. He tries again. “I think I have gastroenteritis.”

The page turning stops. “Are you contagious? Get out.”

“No! I’m fine. I think.”

“You think?”

Sylvain frowns again. “Yes. If I were contagious, I would’ve spread it to Ingrid, but she’s fine? She even finished the rest of my meal.”

Felix snorts immediately. “Yeah, okay. That explains it. You didn’t catch a stomach bug.”

He pauses and sits up. “What’s that supposed to mean?”

Felix sighs and shuts his notebook, whirling around in his chair to give him an unimpressed look. “How much time have you spent with Ingrid in the past month?”

Sylvain’s brow furrows. “I don’t know, we’ve been studying for the practical almost every single day.”

“Right. And how many hours have you spent in the lab with her after classes?”

“I don’t know. Averaging five to seven?”

“And _how_ many other people are there by the time you’re finished?”

He rubs a tired hand across his face and wrinkles his nose at the lingering smell of formalin. _He needs to shower._ “What are you getting at, Felix?”

His childhood best friend rolls his eyes and flips open his notebook again. “Go take a damn shower, I can smell you from over here.”

“If I didn’t catch a bug, then what did I catch?”

Felix throws a towel in his general direction, smacking him in the face. Huffing, Sylvain swings his legs off the bed and walks into their shared bathroom, muttering all the way. “Didn’t catch a bug… then what, huh?”

Under the spray of hot water, he takes to reviewing the material from the last seven hours. _Blood supply to the GI. Celiac trunk. Superior mesenteric artery. Inferior mesenteric artery. Ingrid’s tongue sticking out of the corner of her mouth. Anatomically important structures. Sphincter of Oddi. First, second, and third segments of the duodenum. Ingrid’s delight in dissecting out the pancreas. Ligament of Treitz. Splenic flexure for Waterhouse-Friderichsen syndrome. Ingrid’s bangs falling out of her braids and her annoyed huff when they fell into the omental fat. Her tiny grateful smile when he braided them back for her._

His eyes snap open.

Felix was right. He didn’t catch a bug.

He caught _feelings._ He’s got _feelings_ -induced gastroenteritis.

Sylvain’s chest constricts uncomfortably, and he hopes it’s a self-limiting disease.

There’s still _three more years_ of medical school.

He jumps out of the shower and slams the door open. “Felix. I need a referral to GI and Cardiology.”

Felix glares at him. “I’m not going to send a—”

“I’ve caught _feelings_ , Felix. _I need you to send a referral—_ ”

“You’re the one with Mercedes’ number!”


	2. history of present illness

**Summary for the Chapter:**

> Sylvain's specialist managed to squeeze him into her schedule in the next two weeks.

**Notes for the Chapter:**

> my attending: have a nice long weekend!  
> me: thanks!
> 
> also me: goes home to continue writing pseudo-medicine
> 
> vacation who

Mercedes slips into the chair across from Sylvain, caramel frappucino in hand, hair pulled back into a loose bun. She’s still in hospital scrubs, stethoscope hanging around her neck, but it was the only free time she had before afternoon rounding. Sylvain was tense, forearms on the table, hands locked in front of him. His drink was untouched and his eyes were darting everywhere but her.

…or darting everywhere to keep an eye out for a _certain someone._

She’d received his frantic text about two weeks ago, but she’d been on an away rotation and wouldn’t be back until today. He’d mentioned something about ongoing abdominal pain and possible reflux, and truly, Mercedes didn’t know what she could do for him.

Then, she got a follow-up text from Ingrid, telling her that Sylvain’s been off ever since the anatomy practical, and she’d appreciate it if she could check-in with him whenever she came back… and everything clicked into place.

She additionally got verbal confirmation from Annette via Felix that Sylvain was _indeed_ not behaving normally.

_Because of a certain someone._

She takes a quiet sip of drink and raises an eyebrow at Sylvain when he finally meets her eyes. He smiles sheepishly at her. “Sorry to make you spend your free time with me, Mercedes.”

She waves her hand and puts her drink down. Pulling out a scrap piece of paper, Mercedes takes out her pen and shifts in her seat. “Well, what brings you to my humble cafeteria office, Sylvain?”

He snorts. “Mercedes, you don’t have to—”

“You asked for a referral, didn’t you? What brings you in today?”

Sylvain narrows his eyes at her and sighs. “I think I’ve caught feelings.”

Mercedes blinks. She didn’t think he’d come out the gate with that. “I see. And when do you think this first started?”

She watches him swirl his straw in his drink, still not taking a sip. “I don’t know.”

“Then when did you first notice this? Were you having symptoms?”

He grimaces suddenly and involuntarily brings an arm around his stomach. “…Two weeks ago. When I sent you that text.”

“For completeness sake, remind me what those symptoms were?”

“I was having some pretty bad abdominal cramping… maybe some reflux too? I felt a burning in my chest.”

“Have you ever had these symptoms before two weeks ago?”

“Maybe? I wasn’t really paying attention.”

Mercedes scribbles down a few more notes and nods sagely. “What were you doing when these symptoms occurred?”

Sylvain eyes dart around the cafeteria and slouches in his seat. “I was… eating with Ingrid.”

She looks up from her paper. “Was it something you ate?”

He shakes his head desperately and rubs at his eyes with both hands. “No… no it wasn’t. It’s Ingrid.”

“Ingrid?”

Sylvain’s hands fall onto the table with a thud, his eyes pleading. “ _Mercedes. Please_.”

Mercedes smiles lightly. “ _Sylvain._ ”

His bottom lip juts out at her and his head joins his hands on the table. “I… I don’t know what to do.”

“Well, describe what you’re feeling now. Nauseous? Anymore burning in the stomach? Or is that only when she’s around?”

He mumbles something into the table and Mercedes snickers. “What was that?”

His props his chin up on his hands and mock-glares at her. “I _said_ , only when she’s around.”

“Any associated symptoms? Chest pain? Sweating? Heart palpitations? Shortness of breath?”

He groans loudly. “ _All_ of those. I get so stupid around her. Nonfunctional even.”

Mercedes hums to herself and scratches a few more notes down and Sylvain watches her pen fly across the paper. “Are you really going to document all of this?”

Her eyes flicker to his and she smiles. “Of course. For billing purposes. I’ll send you a copy for your records.”

“For my—”

“Anyhow, what do you think happened? What changed?”

Sylvain flushes and looks away from her. “I’m not sure… I’d just been spending so much time studying with her for the anatomy practical. We were doing things we’d always been doing and, I don’t know. I braided her hair back after it fell into our dissection field and the smile she gave me knocked the wind out of me… and I just… I want to see her smile like that again. For me.”

“Off the record, that’s adorable Sylvain.”

“Off the record, please don’t tell her about this Mercedes. I know she texted you.”

Mercedes reaches over and grasps his hand. “What are you so afraid of?”

He visibly deflates and his voice drops to a whisper, “I don’t want to lose her, Mercedes.”

She thinks back to a certain study session just a few months back and smiles gently. “On the record, I don’t think you’ll have to worry about that.”

“How can you be so sure?”

“Ingrid has stuck with you through thick and thin, I don’t think you having genuine feelings for her would be what makes her run.”

Sylvain gulps and runs a hand through his hair. “It’d make _me_ run… It _has_ made me run.”

Mercedes pats him on the shoulder. “Then, we should both be grateful that Ingrid isn’t you.” Glancing quickly at her watch, she stands from her seat. “I’ve got to get going, but I’ll send you a copy, as promised.”

Sylvain stands quickly too. “Mercedes, you really don’t have to—”

“Oh, I intend to document this conversation, Sylvain. Billing purposes.”

“Billing—”

“And, so you can have my full recommendations in writing.”

He plops back in his chair and lets his head fall back. “You’re really getting a kick out of this, aren’t you?”

Mercedes smiles and winks. “Thank you for letting me participate in your care, Mr. Gautier. I’ll be in touch shortly.”

**Notes for the Chapter:**

> i'm really about to write another patient note huh


	3. assessment and plan

**Summary for the Chapter:**

> Mercedes has one last patient note to finish to top off her work day.

**Notes for the Chapter:**

> triple post gang

Dear esteemed colleagues,

I’ve had the pleasure of participating in the care of Mr. Sylvain Jose Gautier. As you know, he is a well known patient to our community practice and has recently presented to my office for the following conditions.

This letter is to inform you of his recent visit, as well as my assessment and recommendations on how to proceed with the continuity of his care.

Regards,

Mercedes von Martritz

* * *

CC: “I think I’ve caught feelings”

HPI: Mr. Sylvain Jose Gautier is a 23 y.o M who is well known to my clinic and presents to my cafeteria office with two week history of nonspecific GI symptoms, including abdominal cramping, nausea, reflux, and burning in the chest.

He endorses associated symptoms of chest pain without radiation, shortness of breath, diaphoresis, and heart palpitations. Patient additionally notes “I get so stupid around her. Nonfunctional even.” However, these symptoms only seem to occur around a certain individual. These symptoms are notably absent on his own, but are exponentially exacerbated in the presence of said individual.

As such, patient has been avoiding this individual at all costs, but this has impacted his daily functioning and seeks assistance on how to return to his baseline.

He states he is unsure when these symptoms truly started, but they became acutely bothersome over a meal with said individual after studying for seven hours in the anatomy lab for an upcoming exam. Patient describes going about his normal routine with this individual when the individual smiled at him. He states, “the smile she gave me knocked the wind out of me.”

After this event, Mr. Gautier reports going to dinner after his study session when his symptoms began. They continued to worsen throughout the night and into the morning. Patient states he left his apartment early to avoid confrontation with this individual as they are roommates. Once he was at a “safe distance”, his symptoms resolved.

14 point review of systems is negative unless otherwise stated in the HPI.

Past medical history: impaired vision (cannot be corrected with lenses), transient executive dysfunction, foot-in-mouth syndrome

Past surgical history: none

Family history: none

Social history:  
Tobacco use – none  
Alcohol use – occasional, “social drinker”  
Illicit drug use – none  
Occupation: medical student  
Living situation: apartment with 3 childhood friends

Allergies: textbooks, common sense, feelings, kiwis

Physical Exam

General: pleasant, well-appearing, mild distress  
HEENT: atraumatic, normocephalic, EOMI  
Cardio: normal S1 and S2, slight tachycardia, regular rhythm  
Lungs: clear to auscultation bilaterally, no increased work of breathing  
Abdominal: deferred  
MSK: moving all extremities spontaneously and dramatically  
Skin: transient erythema of the cheeks, no edema noted  
  


Assessment & Plan

Mr. Sylvain Jose Gautier is a pleasant 23 y.o M with past medical history significant for impaired vision (cannot be corrected with lenses), transient executive dysfunction, foot-in-mouth syndrome, who presents to my office with two week history of nonspecific GI symptoms with accompanying atypical chest pain, shortness of breath, diaphoresis, and nausea. He reportedly found resolution of symptoms when avoiding his exacerbating factor, but would like to return to his baseline functioning status while in the presence of said individual.

  1. Transient chest pain, shortness of breath, diaphoresis, and nausea in the setting of a roommate as exacerbating factor 
    1. Symptoms initially concerning for STEMI/NSTEMI picture, but less likely in absence of additional cardiac risk factors
    2. Differential diagnosis includes: panic attack, anxiety, executive dysfunction, allergic reaction to feelings
    3. Recommend: slow exposure therapy vs flooding therapy to said individual – if successful, recommend further in-depth conversation to resolve unsaid tensions
  2. Non-specific GI symptoms 
    1. Initially thought to be gastroenteritis, less likely to be viral or bacterial as patient’s roommate is unafflicted
    2. Differential diagnosis includes: lactose intolerance, allergic reaction to feelings, GERD, stress related to exams
    3. Recommend diet modification: less spicy foods, less acidic foods. Trial over-the-counter antacids if heart-burn symptoms continue
  3. Executive dysfunction, exacerbation secondary to probable reaction to feelings 
    1. Recommendation: _talk to her_
    2. Would additionally recommend follow-up with his primary care provider: Ingrid Brandl Galatea



* * *

Sylvain receives a copy of Mercedes’ note in his inbox and he pales.

_His primary care provider: Ingrid Brandl Galatea_

His eyes quickly jump back up to the emailing list, but finds that he is blind copied.

Felix was right. He shouldn’t have asked for a referral.

**Notes for the Chapter:**

> if i'm going to do this for the rest of my life, might as well enjoy it right

**Author's Note:**

> me living my best sub-internship life and hitting more fluff brainblasts :')


End file.
